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Hyperthyroidism: Likelihood Ratios

Introduction: Hyperthyroidism is often caused by Graves disease, with activating antibodies against the TSH receptor.

Note that signs and symptoms of hyperthyroidism differ based on the age of the patient population, with older patients presenting more as apathetic hyperthyroidism (more apathy, anorexia) versus the typical diarrhea / tremor / nervousness / heat intolerance of younger patients. Older patients are more likely to be confused and much more likely to manifest atrial fibrillation.

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Tags: Endocrine Tag this Diagnosis.

Prevalence

Population / CalculatorPrevalence Comments / Study / Link
Older US adults 2% 2% overall, 0.7% excluding iatrogenic cases

J Am Geriatr Soc. 1996 Jan;44(1):50-3. PMID: 8537590

http://gerontoprevention.free.fr/articles/hyperthyroidie.pdf

Hospitalized inpatients with atrial fibrillation 1% Another study found prevalence of 5%, though with only 6 weeks of follow-up.

Arch Intern Med. 1999 Apr 12;159(7):658-65. PMID: 10218744

Hospitalized inpatients 1% Note that many hospitalized patients are transiently hypo/hyper-thyroid! Biggest offender is glucocorticoids, according to the paper.

Arch Intern Med. 1999 Apr 12;159(7):658-65. PMID: 10218744

More, Edit...

The likelihood ratios of findings for Hyperthyroidism are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %. Post-Test Probability (Predictive Value): %. Switch to display mode.
**Note that calculating probabilities from more than one finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)
Good Positive and Negative Likelihood Ratios
FindingResult +LR-LR
[ + ] TSH + 0 - 13.10.1
[ + ] Free T4 + 0 - 13.70.2
[ + ] Free T4 + 0 - 11.10.2
[ + ] Free T3 + 0 - 7.20.2
[ + ] Tachycardia + 0 - 2.50.4
Good Positive Likelihood Ratio
FindingResult +LR-LR
[ + ] Nervousness + 0 - inf0.7
[ + ] Hyperreflexia + 0 - inf0.7
[ + ] Increased Sweating + 0 - inf0.8
[ + ] Polydipsia + 0 - inf0.8
[ + ] Muscular Atrophy + 0 - inf0.8
[ + ] Heat intolerance + 0 - inf0.9
[ + ] Apathy + 0 - 10.30.6
[ + ] Confusion + 0 - 80.9
[ + ] Diarrhea + 0 - 60.8
[ + ] Weight loss + 0 - 50.6
[ + ] Weakness + 0 - 4.50.8
[ + ] Anorexia + 0 - 3.60.7
[ + ] Dyspnea + 0 - 2.70.7
Poorly Diagnostic Findings
FindingResult +LR-LR
[ + ] Constipation + 0 - 1.31
[ + ] Depression + 0 - 1.60.9
[ + ] Tremor + 0 - 1.40.8
[ + ] Fatigue + 0 - 1.80.6
[ + ] Increased Appetite Sensitivity = 57%
[ + ] Goiter Sensitivity = 50%
[ + ] Atrial Fibrillation Sensitivity = 35%
Findings With Unspecified Accuracy
FindingResult +LR-LR
[ + ] Palpitations No accuracy specified.